State Health Policy and Substance Use Disorder Treatments

The Milbank Memorial Fund plays a crucial role in shaping state health policy by collaborating with decision-makers focused on enhancing population health. The organization supports programs designed for legislative and executive officials with the goal of improving public health outcomes. By sharing policy insights and analyses, the Fund aims to cultivate strong state health leadership, effective primary care systems, and cost-efficient healthcare solutions.

The Fund produces an extensive range of publications, including The Milbank Quarterly, along with reports and case studies crafted to inform health policy perspectives. Centered on advancing population health and equity, the foundation is committed to supporting state-level initiatives that address these critical areas.

Recent findings in The Milbank Quarterly spotlight the pivotal role of Medicaid, the largest funder of substance use disorder (SUD) treatments, where managed care oversees benefits for the majority of enrollees. Despite state-imposed coverage mandates for SUD medications, there remains uncertainty about the compliance levels of these policies within managed care settings.

An analysis linked a 2021 survey of state Medicaid officials' requirements for SUD medication benefits with data from 167 Medicaid managed care plans. This research aimed to assess the adherence of these plans to state coverage mandates, taking into account the prevailing political climate of each state.

The study revealed that Medicaid plans generally exhibited higher compliance with coverage mandates for alcohol use disorder medications compared to opioid treatments. States with Democratic majorities were more likely to mandate a wide range of SUD medications, although coverage for methadone was an exception. In contrast, Republican-majority states showed less comprehensive alignment, with 45.4% of plans not meeting methadone coverage requirements and exhibiting less agreement with bans on prior authorizations for SUD medications.

This analysis highlights a trend where Medicaid managed care plans in Republican-majority states are less aligned with state directives regarding coverage and prior authorization for SUD treatments, except for methadone. Such inconsistencies in applying regulatory requirements based on political orientation could significantly impact the provision of comprehensive care.